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Introduction: The systemic immune inflammation index (SII), based on lymphocyte, neutrophil, and platelet counts, has been shown to be an independent indicator of no-reflow phenomenon during percutaneous intervention. However, the relationship between SII and no-reflow phenomenon (NRP) that develops after the procedure of saphenous vein grafts is unknown., Aim: In this study, we aimed to investigate the relationship between no-reflow phenomenon and SII during percutaneous intervention on saphenous vein grafts., Material and Methods: A total of 133 patients who underwent percutaneous intervention for saphenous vein grafts due to acute coronary syndrome between 2019 and 2022 were included in this study. The receiver-operating characteristics (ROC) curve was used to determine the cut-off value of SII to predict the no-reflow. The multivariate regression was used to analyse the correlation between no-reflow and SII., Results: The median value of SII was significantly higher in patients with no-reflow in comparison with normal reperfusion (543 (447, 717) vs. 861 (642, 1272), p < 0.001). The optimal threshold for SII in predicting the no-reflow phenomenon was 613, with sensitivity and specificity of 84% and 66%, respectively. The area under the ROC curve (AUC) was 0.80 (95% CI: 0.73-0.89, p < 0.001). In multivariate analysis, SII ≥ 613 showed an independent predictive value for the no-reflow (OR = 4.02, 95% CI: 1.40-11.57, p < 0.001)., Conclusions: Our results showed that high SII levels were independently associated with the development of no-reflow phenomenon in patients presenting with acute coronary syndrome and undergoing percutaneous intervention to the SVG., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Termedia Sp. z o. o.)

In this study, we aimed to evaluate the utility of the immune-inflammation index (SII) in estimating the no-reflow phenomenon and short-term cardiovascular prognosis in patients with ST-segment elevation myocardial infarction (STEMI). 723 consecutive patients with STEMI who underwent primary percutaneous coronary intervention (PCI) were enrolled in our study. The receiver-operating characteristics (ROC) curve was used to determine the cut-off value of SII to predict the no-reflow. The multivariate regression analysis analyzed the correlation between no-reflow and SII. The median value of SII was significantly higher in patients with no-reflow in comparison with normal reperfusion [1466 (939-2409) vs 905 (566-1379), p < .001]. The optimal threshold for SII in predicting the no-reflow phenomenon was 1036, with sensitivity and specificity of 70% and 59%, respectively. The area under the ROC curve (AUC) was 0.71 (95% CI, 0.66-0.75, p < .001). In multivariate analysis, SII ≥ 1036 value showed an independent predictive value for the no-reflow (OR = 0.51, 95% CI: 0.29-0.92, p = .02) and the 30-day cardiovascular mortality (OR = 2.37, 95% CI: 1.34-4.19, p = .003). Our results suggest that higher SII levels are independently associated with the no-reflow phenomenon and 30-day mortality in STEMI patients undergoing primary PCI.

Background: Endovascular treatment of Buerger's disease is challenging, which usually impedes antegrade revascularization options. We aimed to evaluate the effectiveness of transpedal retrograde approach in patients with Buerger's disease with ambiguous proximal caps and/or previously failed endovascular intervention via antegrade approach., Methods: Eighteen patients with the diagnosis of Buerger's disease who had previously failed antegrade endovascular interventions and/or ambiguous proximal caps were enrolled. Baseline demographic characteristics, severity of critical limb-threatening ischemia, wound scores, postprocedural pedal loop scores, and recovery or amputation rates were recorded., Results: The patients presented with ischemic rest pain (n = 5, Rutherford stage 4), ischemic ulcers with minor tissue loss (n = 8, Rutherford stage 5), and severe ischemic ulcers or gangrene with major tissue loss (n = 5, Rutherford stage 6). Preprocedural wound score according to Saint Elian Wound Score System (SEWSS) was 15.72 ± 5.05. Retrograde transpedal puncture was achieved with an 89% success rate. Postintervention angiographic success rate was 100%. Postintervention Rutherford stage improved compared with preprocedural Rutherford stages (P<.01). In addition, the average SEWSS score decreased significantly after the interventions (P<.001). Postprocedural pedal loop score was found to be associated with SEWSS scores and amputation rates., Conclusions: Transpedal retrograde approach is a technically feasible and potentially effective treatment modality for Buerger's disease and may be considered as a first-line treatment option in the treatment of limb salvage, especially when proximal caps of target vessels are ambiguous or antegrade approach is unsuccessful.

Objective: The systemic immune inflammation (SII) index has been an excellent prognostic indicator in patients with acute ischemic stroke (AIS). In this study, we assessed the utility of the SII in predicting the prognosis and reperfusion status of patients with AIS who underwent endovascular treatment (EVT)., Patients and Methods: 123 consecutive AIS patients were enrolled in our study. The receiver-operating characteristics (ROC) curve was used to determine the cut-off value of SII for predicting unsuccessful cerebral reperfusion. Multivariate logistic regression analysis analyzed the association between SII and unsuccessful reperfusion rate after EVT., Results: The median value of SII was significantly higher in patients with unsuccessful reperfusion compared to patients with successful reperfusion [2,029 (1,217-2,771) vs. 1,172 (680-2,145) respectively, p=0.003)]. A ROC curve analysis showed that the best cut-off value of SII for predicting unsuccessful reperfusion status was 1,690, with sensitivity and specificity of 71% and 69%, respectively. The area under the curve (AUC) was 0.673 (95% CI; 0.552-0.793). Multivariate analysis demonstrated that SII ≥ 1,690 value was an independent predictor of unsuccessful cerebral reperfusion and unfavorable clinical outcome after EVT (Hazard ratio - H.R.=3.713, 95% CI: 1.281-10.76, p=0.016, HR=2.28, 95% CI: 1.06-4.88, p=0.035, respectively)., Conclusions: We suggested that SII is a potential indicator to predict the unsuccessful cerebral reperfusion and unfavorable clinical outcome for patients with AIS undergoing EVT.

Objective: This study aimed to evaluate the effects of statin response on cardiovascular outcomes in patients with ST-segment elevation myocardial infarction., Methods: A total of 1029 ST-segment elevation myocardial infarction patients were enrolled in the study. The patients who failed to achieve >40% reduction in baseline low-density lipoprotein cholesterol levels within 30 days to 12 months after statin initiation were defined as suboptimal statin responders. The adjusted hazard ratios for cardiovascular outcomes for low-density lipoprotein cholesterol response to statins were estimated via the Cox proportional regression model. The relationship between the statin response and cardiovascular outcomes was also evaluated in a subgroup of on-treatment low-density lipoprotein cholesterol levels below 55 mg/dL., Results: Among the study population, 573 (55.6%) patients demonstrated suboptimal low-density lipoprotein cholesterol response to statin therapy. These patients showed a significantly higher incidence of the composite of major adverse cardiovascular events, including cardiovascular death, reinfarction, recurrent myocardial infarction, and target vessel revascularization during the follow-up compared with optimal responders (adjusted hazard ratios 3.99; 95%CI 2.66-6.01; p<0.001). In a subgroup of patients with on-treatment low-density lipoprotein cholesterol levels below 55 mg/dL, suboptimal statin responders also showed unfavorable cardiovascular outcomes (adjusted hazard ratios 8.73; 95%CI 2.81-27.1; p<0.001)., Conclusions: The present study showed that over half of the patients with ST-segment elevation myocardial infarction did not exhibit optimal low-density lipoprotein cholesterol response to statin. These patients have an increased risk of future major adverse cardiovascular events.

Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Background : Identification of target organ damage and/or risk-enhancing factors help treatment decisions in hypertensive and hyperlipidaemic patients who reside in borderline to an intermediate risk category based on 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimates. Aim : In the present study, we aimed to investigate the comparative efficacy of certain hypertension-mediated organ damage markers (HMOD) for the prediction of 10-year ASCVD risk ≥10%, in patients with primary hypertension without established CVD. Methods : One-hundred thirty-seven asymptomatic hypertensive patients ≥40 years of age were enrolled in the present study. Ten-year ASCVD risks were estimated by Pooled Cohort Equations. The following HMOD markers; pulse pressure (PP), left ventricular mass index (LVMI), carotid intima-media thickness (CIMT), ankle-brachial index (ABI), cardio-ankle vascular index (CAVI) and estimated glomerular filtration rate (eGFR) were evaluated with respect to efficacy for predicting ≥10% ASCVD risk with ROC analysis. Results : CAVI gave the greatest Area Under Curve (AUC = 0.736, p < .000), and followed by CIMT (AUC = 0.727, p < .000), LVMI (AUC = O.630, p = .01), and PP (AUC = 0.623, p = .02). ABI and eGFR were not found to be predictive. CAVI correlated best with estimated 10-year ASCVD risk ( r = 0.460, p < .000). A CAVI value ≥8 was found 71% sensitive and 72% specific for predicting ≥10% risk in 10-year ASCVD risk scale. CAVI gave the best graded response to increments in 10-year ASCVD risk categories. Conclusion : We suggest that CAVI is the best surrogate for 10-year ASCVD risk, among several HMOD markers.

Introduction: In patients undergoing haemodialysis, cardiovascular mortality and morbidity, characterised by accelerated atherosclerosis and increased inflammation, are elevated. Salusins are newly defined molecules in the atherosclerotic processes, and while salusin-alpha (Sal-α) acts as an antiatherogenic factor, salusin-beta (Sal-β) has a proatherogenic role. Their roles are as yet undefined in patients undergoing haemodialysis., Methods: In this cross-sectional study, salusin levels, carotid intima-media thickness (CIMT) from the common carotid artery and pulse wave velocity (PWV) were measured for 180 patients undergoing haemodialysis and 90 healthy controls., Results: Mean Sal-α and Sal-β levels in patients undergoing haemodialysis (Sal-α: 726.4 ± 578.7 pg/mL; Sal-β: 1,080.4 ± 757.1 pg/mL) and healthy controls (Sal-α: 325.8 ± 303.7 pg/mL; Sal-β: 268.1 ± 409.0 pg/mL) were determined. Negative correlation was observed between Sal-α levels and CIMT (patients undergoing haemodialysis: r = -0.330, p < 0.0001; healthy controls: r = -0.223, p = 0.035) and PWV (patients undergoing haemodialysis: r = -0.210, p = 0.005; healthy controls: r = -0.378, p < 0.0001) in both groups. In patients undergoing haemodialysis, positive correlation was observed between Sal-β/Sal-α ratio and CIMT (r = 0.190, p = 0.012) and PWV (r = 0.155, p = 0.041). On subgroup analysis, Sal-α levels were found to be low in patients with diabetes mellitus., Conclusion: Patients undergoing haemodialysis have higher Sal-β and Sal-α levels, and their higher Sal-β/Sal-α ratio, in comparison with healthy controls, might have cardiovascular risk implications., (Copyright: © Singapore Medical Association.)

Objective: Identification of the asymptomatic target organ damage (AOD) helps to stratify the overall risk of cardiovascular (CV) diseases and guides a treatment decision in hypertensive patients without a symptomatic CV or renal disease. The endothelial-cell-specific molecule 1 (endocan) is regarded as a novel marker of endothelial dysfunction. Its release is increased in hypertensive patients, especially those with symptomatic CV and renal disease. In the present study, we aimed to evaluate the endocan levels in asymptomatic hypertensive patients with or without AOD., Methods: The study included 132 asymptomatic hypertensive patients, and 101 of who had at least one AOD., Results: Serum endocan levels did not differ between patients with and without AOD (3.81±0.78 vs. 3.83±0.63 ng/mL, p=0.88). An analysis according to the presence of any specific AOD did not show any difference between groups. No significant correlation was found between serum endocan levels and any of the continuous variables related to AOD, such as the pulse pressure, carotid intimae-media thickness, cardio-ankle vascular index, ankle-brachial index, left ventricular mass index, Sokolow-Lyon index, Cornell voltage-duration product, and estimated glomerular filtration rate., Conclusion: Endocan may not serve as a useful biomarker at asymptomatic vascular stages of hypertension, despite its role in indicating disease severity and inflammatory activation in advanced symptomatic CV and renal disease.

Introduction: Direct stenting (DS) is associated with improved markers of reperfusion during primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). However, data evaluating its impact in small vessel coronary artery disease (CAD) are lacking., Aim: To compare DS and conventional stenting (CS) for small vessel CAD on clinical outcomes of patients with STEMI undergoing PPCI., Material and Methods: A cohort of 616 STEMI patients treated with DS (202 patients) or CS (414 patients) in small vessel (≤ 2.75 mm) lesions was retrospectively analyzed. The primary endpoint was to compare the occurrence of major adverse cardiac events (MACE) between groups during 2-year follow-up. The secondary end points included in-hospital target lesion revascularization (TLR) and in-hospital death., Results: The primary end-point, MACEs, occurred in 9.2% in the DS group and 12.3% in the CS group ( p > 0.05). The rates of TLR, myocardial infarction (MI) and target vessel revascularization (TVR) were not significantly different between groups ( p > 0.05). The stent thrombosis (ST) rate was significantly lower in the DS group (1.0% vs. 4.2%, p = 0.04) at 2 years. However, DS was not found to be an independent predictor of ST in multivariate analysis. There were no significant differences in in-hospital rates of death and TLR. The DS compared to CS resulted in greater rates of postprocedural TIMI grade 3 flow, and lower risk of edge dissection. The procedure time, radiation exposure and contrast administration were found to be significantly lower in the DS group., Conclusions: In selected patients with STEMI undergoing PPCI for small vessel CAD, DS is not only safe and feasible but also reduces ST rates, contrast load, and procedural and radiation exposure time., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2019 Termedia Sp. z o. o.)

Background: Atrial fibrillation is one of the most common abnormal heart rhythms. Neutrophil-lymphocyte ratio (NLR) has emerged as a potential marker for the level of inflammation in cardiac disorders., Hypothesis: NLR might be associated with thrombosis and bleeding risk scores and might predict cardioembolic risk in nonvalvular atrial fibrillation (NVAF) patients within the therapeutic international normalized ratio (INR)., Methods: We enrolled 272 patients taking warfarin for NVAF and classified them into 2 groups: Group A consisted of patients (n = 132) whose time in therapeutic range (TTR) was ≥65%, and Group B comprised patients (n = 139) whose TTR was <65%., Results: NLR values were higher in group B than in group A (P < 0.0001). Patients classified as high risk according to CHA 2 DS 2 -VASc score had significantly higher NLR levels (P = 0.002) than those classified as low and intermediate risk. Furthermore, NLR levels were significantly correlated with CHA 2 DS 2 -VASc and HAS-BLED scores (P < 0.001 and P < 0.0001, respectively). NLR predicted patients within therapeutic INR range (TTR ≥65%) with sensitivity of 81% and specificity of 71% in a receiver operator characteristic curve analysis, using a cutoff value of 2.17. Area under the curve for NLR was 0.81 (P < 0.0001)., Conclusions: To our knowledge, this is the first study showing correlation of NLR with both CHA 2 DS 2 -VASc and HAS-BLED risk scores. NLR might represent a useful marker to identify patients with high risks of stroke and bleeding and may have predictive value in identifying patients within the therapeutic INR range., (© 2018 Wiley Periodicals, Inc.)

Objective: Left ventricular (LV) rotation and twist play an important role in LV contraction and relaxation. Left bundle branch block (LBBB) deteriorates both diastolic and systolic functions. We evaluated the LV twist in patients with LBBB and preserved ejection fraction (EF) (>50%) to determine twist as a potential marker for subtle myocardial dysfunction., Methods: This observational cross-sectional study included 34 LBBB patients with preserved EF who were free from ischemic and valvular disease (Group 1) and 36 healthy controls (Group 2). All patients underwent 2-D Doppler and 2-D speckle tracking echocardiography. LV apical, basal rotation, and twist were evaluated in both groups and compared accordingly. In addition, subjects were dichotomized considering the median twist value of the study population. Binary logistic regression analysis was performed to determine the independent variables associated with inframedian twist., Results: Baseline clinical characteristics were similar in LBBB patients and controls. Mean apical rotation (2.5°±1.9° vs. 4.4°±2.9°; p=0.002), basal rotation (-2.9°±2.3° vs. -4.1°±2.7°; p=0.05), and twist (5.4°±3° vs. 8.6°±3.3°; p<0.001) were decreased in group 1. Parameters related to intra- and interventricular mechanical dyssynchrony, such as longitudinal left ventricular dyssynchrony index (LVdys) and preejection interval of LV, interventricular mechanical delay (IVMD), and left posterior wall contractions (SPMWD) were significantly higher in the LBBB group. The median twist value of the studied population was 6.65°. Binary logistic regression analysis showed that only presence of LBBB was independently associated with inframedian twist (OR=6.250; 95% CI: 2.215-17.632; p<0.001)., Conclusion: The LBBB might have induced the reduction of LV twist by diminishing the LV rotation before inducing a prominent effect on the left ventricular ejection fraction (LVEF). Therefore, twist may be considered as a marker for subtle LV dysfunction in LBBB with substantially normal EF.

Aim: This study aimed to evaluate the cardiac autonomic dysfunction and the cardiac arrhythmia risk using heart rate variability parameters in subjects with vitamin D deficiency and low cardiovascular risk., Material and Methods: One hundred five consecutive individuals, 54 patients with low vitamin D status and 51 healthy controls were enrolled in this study. The overall cardiac autonomic tone was quantified by using various heart rate variability parameters included mean RR interval, mean Heart Rate, mean of standard deviations of intervals for 24 hours (SDNN), standard deviation of averages of intervals (SDANN), mean of standard deviation of intervals for 5 minutes (SDNNI), root mean square of difference of successive intervals (rMSSD) and the proportion of intervals differing more than 50 ms (pNN50) values. The 12-lead ECG was recorded from each participant, and QT intervals were measured., Results: Baseline demographic profiles were similar between two groups. The heart rate variability parameters such as mean RR interval, mean HR, SDNN, SDANN, SDNNI, rMSSD and pNN50 (%) values were not significantly different in patients with low vitamin D status compared to control group. The electrocardiography analysis revealed only slight but significant prolongation of corrected QT (QTc) intervals in the control group., Conclusion: HRV variables were not significantly altered in patients with vitamin D deficiency in low cardiovascular risk profile group. Further studies evaluating these findings in other cohorts with high cardiovascular risk are required.

Introduction: Carotid artery stenting (CAS) is a promising alternative to surgery in high-risk patients. However, the impact of stent cell design on outcomes in CAS is a matter of continued debate., Aim: To compare the periprocedural and clinical outcomes of different stent designs for CAS with distal protection devices., Material and Methods: All CAS procedures with both closed- and hybrid-cell stents performed at our institution between February 2010 and December 2015 were analyzed retrospectively. Adverse events were defined as death, major stroke, minor stroke, transient ischemic attack and myocardial infarction. Periprocedural and 30-day adverse events and internal carotid artery (ICA) vasospasm rates were compared between the closed-cell and hybrid-cell stent groups., Results: The study included 234 patients comprising 146 patients with a closed-cell stent (Xact stent, Abbott Vascular) (mean age: 68.5 ±8.6; 67.1% male) and 88 patients with a hybrid-cell stent (Cristallo Ideale, Medtronic) (mean age: 67.2 ±12.8; 68.2% male). There was no significant difference between the groups with respect to periprocedural or 30-day adverse event rates. While there was no difference in terms of tortuosity index between the groups, there was a higher procedural ICA vasospasm rate in the closed-cell stent group (35 patients, 23%) compared with the hybrid-cell stent group (10 patients, 11%) ( p = 0.017)., Conclusions: The results of this study showed no significant difference in the clinical adverse event rates after CAS between the closed-cell stent group and the hybrid-cell stent group. However, procedural ICA vasospasm was more common in the closed-cell stent group.

Aorto femoral bypass is usually the recommended therapy for diffuse disease involving the aorta and iliac arteries. In this case report, a case involving a chronic endovascular abdominal aortic stent graft occlusion in which percutaneous angioplasty was performed via a transbrachial and transfemoral approach is presented. This case emphasized that occlusion of an endovascular abdominal aortic stent graft can also be treated, primarily, with an endovascular technique., (© The Author(s) 2016.)

Background: Carotid artery stenting (CAS) is currently used as an alternative treatment to carotid endarterectomy (CEA). The objective of this study was to analyse our 5-year experience performing CAS. Secondarily, we sought to determine independent risk factors which predict periprocedural complications., Patients and Methods: A total of 146 patients who underwent 153 CAS procedures were analysed. The majority of patients (123, 84.2%) had symptomatic carotid stenosis. Demographic and interventional data, angiographic lesion characteristics, and periprocedural complications were recorded. Using univariate and multivariate logistic regression analyses, risk factors associated with adverse clinical outcomes were determined., Results: Periprocedural neurological complications, including four (2.7 %) major strokes, three (2 %) transient ischaemic attacks, one (0.7%) amaurosis fugax, and two (1.3 %) cases of hyperperfusion syndrome occurred in ten (6.8%) patients. The incidence of periprocedural complications significantly increased in female patients (r = 0.214, p = 0.009) and patients with longer lesions (r = 0.183, p = 0.027), contralateral stenosis ≥50 % (r = 0.222, p = 0.007), the presence of complicated plaques (r = 0.478, p < 0.001) and inadequate glycaemic control (r = 0.259, p = 0.002). Multivariate regression analysis also determined four variables to be potential independent risk factors for 30-day adverse events: higher age (Odds ratio [OR] = 1.283; 95 % CI, 1.051 to 1.566, p = 0.014); longer lesions (OR = 1.459, 95 % CI, 1.124 to 1.893, p = 0.004); higher tortuosity index (OR = 1.015, 95 % CI, 1.001 to 1.030, p = 0.034), and the presence of complicated plaque morphology (OR = 4.321, 95 % CI, 1.621 to 10.23, p = 0.001)., Conclusions: Patient and lesion characteristics including age, lesion length, complicated plaque morphology and tortuosity index, may be associated with periprocedural complications.

Introduction: Pulse transit time (PTT) is the duration that a pulse wave takes to travel between two different arterial points, and it may be useful in estimating blood pressure. The aim of this study was to investigate the PTT during carotid artery stenting, as well as its value in blood pressure estimation., Method: Thirty-four patients with critical carotid artery stenosis were enrolled in this study. The carotid PTT from the onset of the R-wave of electrocardiography to the pulse waveform at the carotid artery, obtained invasively during carotid artery catheterization, was measured. The carotid PTT was measured before and after stenting of the internal carotid artery., Results: The mean age was 70.4±8.0 years among the 34 patients enrolled (eight female patients, 21.9%). Measurements were obtained before and after carotid artery stenting. The heart rate (85.9±15.9 vs. 76.9±12.5 bpm, P<0.01), systolic blood pressure (162.8±28.6 vs. 126.0±31.7 mmHg, P<0.001), diastolic blood pressure (87.7±17.9 vs. 76.9±20.0 mmHg, P<0.01), and mean blood pressure (112.7±18.6 vs. 93.2±22.7 mmHg, P<0.001) were significantly decreased, whereas the carotid PTT (0.06±0.012 s vs. 0.07±0.012 s, P<0.001) was significantly increased after carotid stenting. The difference between the PTTs was negatively correlated with the systolic blood pressure (r=-0.35, P=0.02) and diastolic blood pressure (r=-0.4, P=0.01)., Conclusion: After carotid stenting, the PTT increases significantly because of the lowering of the blood pressure. However, the relationship is not strong enough for the PTT to be used for blood pressure estimation.

Carotid artery stenosis (CAS) is primarily caused by atherosclerotic plaque. Progressive inflammation may contribute to the rupture of an atherosclerotic plaque. The platelet-to-lymphocyte ratio (PLR) is a new and simple marker that indicates inflammation. In this study, we aimed to investigate the use of the PLR to determine the severity of CAS. One hundred forty patients were chosen from among patients who underwent carotid angiography in our institution. Symptomatic patients with stenosis >50% in the carotid arteries and asymptomatic patients with stenosis >80% were diagnosed via carotid angiography as having critical stenosis. Patients were classified into two groups. Group 1 included patients who had critical CAS, whereas Group 2 included patients with noncritical CAS, as determined by carotid angiography. Correlations between the PLR and the severity of CAS were analyzed. There were no significant differences in sex and age between the two groups. The PLR was 162.5 ± 84.7 in the noncritical CAS group patients and 94.9 ± 60.3 in the critical CAS group patients (p < 0.0001). The PLR value of 117.1 had 89% sensitivity and 68% specificity for CAS [95% confidence interval, 0.043-0.159; area under the curve, 0.101 ± 0.03)]. In this study, we have shown that PLR values may be associated with critical stenosis in at least one of the carotid arteries. Furthermore, PLR values may be used to predict critical stenosis in the carotid arteries., (Copyright © 2016. Published by Elsevier Taiwan.)

Objective: The aim of this study was to evaluate the left (LV) and right (RV) ventricular function in euthyroid Hashimoto's thyroiditis (eHT) patients., Subjects and Methods: Forty-five patients diagnosed with eHT and 45 age- and gender-matched control subjects were enrolled in this study. Echocardiographic parameters reflecting RV and LV functions such as chamber dimensions, ejection fraction, fractional shortening, conventional and tissue Doppler-derived early and late filling velocities (E, A, E', A'), isovolumic relaxation (IVRT) and contraction (IVCT) times, ejection time (ET), deceleration time (DT), Tei index, pulmonary acceleration time (PAcT) and tricuspid annular plane systolic excursion (TAPSE) of patients with eHT were compared to those of control subjects using the paired-samples t test or Wilcoxon signed-rank test., Results: Regarding the LV function, compared to the controls patients with eHT had a higher LV-Tei index (0.6 ± 0.2 vs. 0.4 ± 0.1, p < 0.001), higher DT (p < 0.001) and IVRT (p < 0.001) values, and higher E/E' ratios (p = 0.04). In contrast, the peak E wave velocity (p = 0.02), E/A ratio (p = 0.01) and ET (p = 0.02) were significantly lower in the eHT group than amongst the controls. The RV, Tei index (0.40 ± 0.11 vs. 0.28 ± 0.07, p < 0.001), TAPSE (2.0 ± 0.3 vs. 2.2 ± 0.2 mm, p < 0.001), PAcT (124.3 ± 22.6 vs. 149.4 ± 18.3 ms, p < 0.001), A' (p = 0.007) and IVCT (p = 0.001) were significantly higher in patients with eHT than the controls. However, the tricuspid E/A ratio (p = 0.01), E' (p = 0.03) and E'/A' ratio (p = 0.001) were significantly lower in the eHT patients than the control group., Conclusions: This study demonstrated that both RV and LV functions were impaired in patients with eHT., (© 2015 S. Karger AG, Basel.)

Background: CHA2DS2-VASc score is the most widely preferred method for prediction of stroke risk in patients with atrial fibrillation. We hypothesized that CHA2DS2-VASc score may represent atrial remodeling status, and therefore echocardiographic evaluation of left atrial electromechanical remodeling can be used to identify patients with high risk., Methods: A total of 65 patients who had documented diagnosis of paroxysmal atrial fibrillation (PAF) were divided into three risk groups according to the CHA2DS2-VASc score: patients with low risk (score=0, group 1), with moderate risk (score=1, group 2), and with high risk score (score ≥2, group 3). We compared groups according to atrial electromechanical intervals and left atrium mechanical functions., Results: Atrial electromechanical intervals including inter-atrial and intra-atrial electromechanical delay were not different between groups. However, parameters reflecting atrial mechanical functions including LA phasic volumes (Vmax, Vmin and Vp) were significantly higher in groups 2 and 3 compared with group 1. Likewise, LA passive emptying volume (LATEV) in the groups 2 and 3 was significantly higher than low-risk group (14.12±8.13ml/m(2), 22.36±8.78ml/m(2), 22.89±7.23ml/m(2), p: 0.031). Univariate analysis demonstrated that Vmax, Vmin and Vp were significantly correlated with CHA2DS2-VASc score (r=0.428, r=0.456, r=0.451 and p<0.001). Also, LATEV (r=0.397, p=0.016) and LA active emptying volume (LAAEV) (r=0.281, p=0.023) were positively correlated with CHA2DS2-VASc score. In the ROC analysis, Vmin≥11ml/m(2) has the highest predictive value for CHA2DS2-VASc score ≥2 (88% sensitivity and 89% specificity; ROC area 0.88, p<0.001, CI [0.76-0.99])., Conclusion: Echocardiographic evaluation of left atrial electromechanical function might represent a useful method to identify patients with high risk., (Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Chordae tendineae rupture process is associated with increased production of inflammatory and angiogenesis mediators in connective tissues, which contributes to chronic inflammation and pathogenesis of degenerative chordae. A few trace elements are known to possess antioxidant, anti-inflammatory, and antiangiogenic properties. Therefore, the aim of this study was to determine whether zinc, selenium, midkine (MK), interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α), vascular endothelial growth factor-A (VEGF-A), platelet-derived growth factor-BB (PDGF-BB), and reduced glutathione (GSH) levels are associated with inflammation and angiogenesis processes in the context of a potential etiology causing aggravation of mitral regurgitation and/or ruptured chordae tendineae. Seventy-one subjects comprising 34 patients with mitral chordae tendineae rupture (MCTR) and 37 healthy controls diagnosed on the basis of their clinical profile and transthoracic echocardiography were included in this study. The levels of GSH, MK, selenium, and zinc were found to be lower in the patients group when compared to control group. There were no significant difference in plasma TNF-α, IL-1β, IL-6, IL-8, VEGF-A, and PDGF-BB levels between two groups. There were positive significant correlations between MK and GSH, MK, and selenium levels in patients with MCTR. According to our data in which selenium, zinc, MK, and GSH decreased in MCTR patients, inflammatory response, oxidative stress, and trace element levels may contribute to etiopathogenesis of mitral regurgitation and/or ruptured chordae tendineae.

Polymorphisms in Lys939Gln XPC gene may diminish DNA repair capacity, eventually increasing the risk of carcinogenesis. The aim of the present study was to evaluate the significance of polymorphism Lys939Gln in XPC gene in patients with mitral chordae tendinea rupture (MCTR). Twenty-one patients with MCTR and thirty-seven age and sex matched controls were enrolled in the study. Genotyping of XPC gene Lys939Gln polymorphism was carried out using polymerase chain reaction- (PCR-) restriction fragment length polymorphism (RFLP). The frequencies of the heterozygote genotype (Lys/Gln-AC) and homozygote genotype (Gln/Gln-CC) were significantly different in MCTR as compared to control group, respectively (52.4% versus 43.2%, p = 0.049; 38.15% versus 16.2%, p = 0.018). Homozygote variant (Gln/Gln) genotype was significantly associated with increased risk of MCTR (OR = 2.059; 95% CI: 1.097-3.863; p = 0.018). Heterozygote variant (Lys/Gln) genotype was also highly significantly associated with increased risk of MCTR (OR = 1.489; 95% CI: 1.041-2.129; p = 0.049). The variant allele C was found to be significantly associated with MCTR (OR = 1.481; 95% CI: 1.101-1.992; p = 0.011). This study has demonstrated the association of XPC gene Lys939Gln polymorphism with MCTR, which is significantly associated with increased risk of MCTR.

Objectives: Patients with carotid disease are frequently referred for carotid artery stenting based on the results of carotid duplex studies. During carotid artery stenting, the stent is usually extended into the common carotid artery, thereby crossing the external carotid artery. Previous studies have shown conflicting results regarding internal carotid stenting and external carotid artery flow velocities, but the effect of stenting on ipsilateral superior thyroid artery velocities has not been defined. This study examined the effect of internal carotid angioplasty and stenting on the ipsilateral superior thyroid artery Doppler-derived flow parameters., Methods: We prospectively studied preinterventional and postinterventional duplex scans obtained from 41 patients (mean age ± SD, 64 ± 10 years) who underwent carotid artery stenting. The Doppler-defined preprocedural peak systolic velocity (PSV) end-diastolic velocity (EDV), resistive index (RI), and pulsatility index (PI) in the ipsilateral external carotid and superior thyroid arteries were compared with postprocedural values., Results: Among patients with stenting, the preprocedural PSV, EDV, RI, and PI in the ipsilateral superior thyroid artery were 30 ± 11 cm/s, 13 ± 6 cm/s, 0.62 ± 0.11, and 1.04 ± 0.28,respectively; after stenting, they were 36 ± 8 cm/s, 14 ± 9 cm/s, 0.71 ± 0.07, and 1.11 ± 0.19. The preprocedural PSV, EDV, RI, and PI in the ipsilateral external carotid artery were 79 ± 24 cm/s, 17 ± 7 cm/s, 0.77 ± 0.26, and 1.27 ± 0.22; after stenting, they were 94 ± 31 cm/s, 20 ± 6 cm/s, 0.80 ± 0.4, and 1.25 ± 0.31. Despite a slight increase in superior thyroid and external carotid artery flow, there was no statistically significant change from before to after stenting., Conclusions: This study showed no differences in blood velocity profiles in the ipsilateral superior thyroid and external carotid arteries after stenting., (© 2014 by the American Institute of Ultrasound in Medicine.)

The case presented is the first patient with concurrent acute interstitial pneumonia and pulmonary embolism associated with combined treatment of peginterferon and ribavirin for hepatitis C.

Rivaroxaban is an oral anticoagulant agent that directly inhibits Factor Xa and interrupts both the intrinsic and extrinsic pathway of the coagulation cascade and is currently indicated for use in patients for atrial fibrillation and prophylaxis of deep venous thrombosis. The present case reports of spontaneous rectus sheath hematoma during rivaroxaban therapy for atrial fibrillation in a 75-year-old woman.

There are various options for the treatment of occluded femoropopliteal (fem-pop) bypass graft. Although surgical revision is the gold standard, it is also associated with higher rates of complications such as nerve injury, wound and graft infection, and bleeding. In this case report we present the case of fem-pop in graft occlusion in which percutaneous angioplasty and stenting was performed to the occluded native fem-pop artery via transpedal pathway. With this case we tried to emphasise that percutaneous intervention to the native artery could be an alternative to surgical treatment.

Background: Patients with non-ST-elevation acute coronary syndrome are heterogeneous in terms of clinical presentation and immediate- and long-term risk of death or non-fatal ischemic events. The aim of the present study was to evaluate the relationship between the Global Registry of Acute Coronary Events (GRACE) score and severity of coronary artery disease angiographically evaluated by Gensini score in patients with non-ST-elevation acute coronary syndrome., Methods: A total of 245 patients with non-ST-elevation acute coronary syndrome were enrolled to the study. Based on the GRACE risk score classification system, the patients were divided into low- (n=97, 39.6%), intermediate- (n=84, 34.3%), and high- (n=64, 26.1%) risk groups. All patients underwent coronary angiography within five days after admission., Results: The Gensini scores were 26±29 in the low-risk group, 29±19 in the intermediate-risk group, and 38±23 in the high-risk group (p=0.016). The low-risk group was significantly different from the high-risk group (p=0.013), and the difference from the intermediate-risk group almost reached significance. Normal, noncritical, one and two, or multivessel disease were identified in 15 (6.1%), 31 (12.7%), 75 (30.6%), and 124 (50.6%) patients, respectively. The prevalence of multivessel disease was 28% in the low-risk group, 30% in the intermediate-risk group, and 42% in the high-risk group. The high-risk group was significantly different from the low-risk group (p<0.01)., Conclusion: Our study demonstrates that the GRACE score has significant value for assessing the severity and extent of coronary artery stenosis in patients with non-ST-elevation acute coronary syndrome., (Copyright © 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with acute coronary syndrome (ACS). We assessed the association between NAFLD and SYNTAX Score (SS) in patients with ACS. Eighty consecutive patients with ACS were enrolled. Patients were evaluated using ultrasound to detect NAFLD and hepatosteatosis stage. The prevalence of NAFLD was 81.2%; median SS was 15. The SS was significantly higher in patients with NAFLD (18 ± 8 vs. 11 ± 5, P = .001). Univariate analysis showed that the stage of NAFLD correlated with SS (r = .6, P < .001). In multivariate binary logistic analysis, increased age (odds ratio [OR], 1.05; 95% confidence interval [CI],1.00-1.10) and presence of NAFLD (OR, 13.20; 95% CI, 2.52-69.15) were independent factors associated with supramedian SS. In conclusion, among patients with ACS, those with NAFLD have more complex CAD as assessed by SS.

The correlation between plasma D-dimer level and reperfusion has not been clarified yet in thrombolytic therapy applied for acute myocardial infarction patients. The aim of this study was to investigate whether there is a relationship between reperfusion and fibrinolytic activity in acute myocardial infarction patients treated with thrombolytic therapy. Fibrinolytic activity was reflected by plasma D-dimer levels. During the study period, 186 patients were initially analyzed. But 18 of these patients were excluded from the study because they were not suitable for study criteria. Blood was collected from 168 acute myocardial infarction patients within first 6 h. Intravenous tissue plasminogen activator (100 mg) or streptokinase (1,500,000 U) was applied to patients. Mean age of the patients was 58 (28-86) years and majority was men (86%). The number of anterior, inferior, and lateral myocardial infarction patients were 76 (45.2%), 85 (50.6%), and seven (4.2%), respectively. The mean time from symptom onset to thrombolytic application was 134 (95-212) min. Reperfusion occurred in 115 (68.5%) patients. D-dimer levels were markedly high after thrombolytic therapy versus before (155 mg/dl, 362 mg/dl, P<0.005). We compared the D-dimer values before and after thrombolytic therapy between reperfused group and the nonreperfused group (189-409 mg/l in reperfused group, P=0.086; 82-258 mg/l in the nonreperfused group, P=0.173). In conclusion, in this study, D-dimer levels were elevated markedly in patients with ST elevation myocardial infarction after thrombolytic therapy, but no significant difference was seen in D-dimer levels between the reperfused and nonreperfused groups.

Renal artery stenosis (RAS) is the most common cause of secondary hypertension and accounts for approximately 1-3% of all causes of hypertension. Over 90% of RASs are caused by atherosclerosis; atherosclerotic RAS is increasingly common in aging populations, particularly elderly people with diabetes, hyperlipidaemia, aortoiliac occlusive disease, coronary artery disease or hypertension. Three therapeutic options are currently available for patients with renovascular hypertension: medical antihypertensive therapy, surgical revascularisation and transluminal angioplasty including stent implantation. We present in this report a male patient with bilateral severe ostial stenosis and coronary artery disease, and who was successfully treated with renal stent implantation in one session.

The development of thrombus on the tricuspid valve is very rare in adulthood and it needs special attention in clinical practice as it can be confused with vegetation or a tumour. Embolisation due to thrombus may have an acute and unexpected course with a detrimental prognosis and a high death rate during the first 24 h after diagnosis. In this report, we presented a case of mobile tricuspid valve thrombus detected by transthoracic echocardiography that led to recurrent pulmonary embolism.

Central venous catheterisation allows delivery of medications, intravenous fluids, parenteral nutrition, haemodialysis and monitoring of haemodynamic variables. Various complications may occur during and after the procedure. However, the complete guidewire retention has rarely been reported. In this report, we have presented a complete guidewire retention as a result of inadvertent catheter insertion. After 17 months of the first operation performed upon the diagnosis of Fournier's gangrene, the patient was admitted to the cardiology polyclinic with a recurrent chest pain. Echocardiography showed a wire-shaped foreign body within the right part of the heart, and a fluoroscopic examination showed a guidewire reaching from the superior vena cava to the right external iliac vein. In retrospect, the wire was already visible on the postoperative chest x-rays and CT taken while the patient was still in intensive care unit, but its presence was overlooked at that time. The guidewire was retrieved completely during a surgery.

Acute ST elevation myocardial infarction has high mortality and morbidity rates. The majority of patients with this condition face erectile dysfunction in addition to other health problems. In this study, we aimed to investigate the effects of two different reperfusion strategies, primary angioplasty and thrombolytic therapy, on the prevalence of erectile dysfunction after acute myocardial infarction. Of the 71 patients matching the selection criteria, 45 were treated with primary coronary angioplasty with stenting, and 26 were treated with thrombolytic agents. Erectile function was evaluated using the International Index of Erectile Function in the hospital to characterize each patient's sexual function before the acute myocardial infarction and 6 months after the event. The time required to restore blood flow to the artery affected by the infarct was found to be associated with the occurrence of erectile dysfunction after acute myocardial infarction. The increase in the prevalence of erectile dysfunction after acute myocardial infarction was 44.4% in the angioplasty group and 76.9% in the thrombolytic therapy group (P=0.008). In conclusion, this study has shown that reducing the time of reperfusion decreases the erectile dysfunction prevalence, and primary angioplasty is superior to thrombolytic therapy for decreasing the prevalence of erectile dysfunction after acute myocardial infarction.

The incidence of multivessel coronary artery ectasias (CAEs) among patients undergoing coronary artery angiography is very rare. All three coronary vessels can be affected by CAE, but most patients have an isolated arterial ectasia, commonly the right coronary artery. In this report we present two cases with inferior myocardial infarction that was likely caused by thrombotic occlusion of CAEs.

The incidence of dual left anterior descending coronary artery (LAD) in normal hearts has been reported to range from 0.13 to 1%. Type IV dual LAD differs from the other three types in the origination of the long LAD from the right coronary sinus. We present a case of type IV dual LAD in a patient with anterior myocardial infarction related to the short LAD.

Background: We have known that patients with renal insufficiency (creatinine level) have increased mortality for coronary artery disease. In this study, the relationship between admission creatinine level and one year mortality are evaluated in patients with acute myocardial infarction (AMI)., Method: 160 AMI patients (127 men and 33 women with a mean age of 59 ± 13) were enrolled in the study. Serum creatinine levels were measured within 12 hours of AMI. The patients were divided into two groups according to admission serum creatinine level. (1) elevated group (serum creatinine > 1.3 mg/dL) and (2) normal group (≤1.3 mg/dL). One year mortality rates were evaluated., Results: Elevated serum creatinine is observed in the 27 patients (16.9%). The mean creatinine level is 1.78 ± 7 mg/dL in the elevated group and 0.9 ± 0.18 mg/dL in the normal group (P < 0.0001). The mortality rate of the elevated group (n = 7, 25.9%) is higher than that of the normal group (n = 9, 6.8%). A significant increase in one year mortality is also observed (P=002) 60., Conclusion: The mildly elevated admission serum creatinine levels are markedly increased to one year mortality in patients with AMI.

Background. B-type natriuretic peptide has been shown to be a very sensitive and specific marker of heart failure. In this study, we aimed to investigate the effect of percutaneous closure of ventricular septal defects with Amplatzer septal occluders on brain natriuretic peptide levels. Methods. Between 2008 and 2011, 23 patients underwent successfully percutaneous ventricular septal defect closure in 4 cardiology centers. Brain natriuretic peptide levels were measured in nine patients (4 male, mean ages were 25.3 ± 14.3) who underwent percutaneous closure with Amplatzer occluders for membranous or muscular ventricular septal defects were enrolled in the study. Brain natriuretic peptide levels were measured one day before and one month after the closure. Patients were evaluated clinically and by echocardiography one month after the procedure. Results. Percutaneous closures of ventricular septal defects were successfully performed in all patients. There was not any significant adverse event in patients group during followup. Decrease in brain natriuretic peptide levels after closure were statistically significant (97.3 ± 78.6 versus 26.8 ± 15.6, P = 0.013). Conclusion. Brain Natriuretic Peptide levels are elevated in patients with ventricular septal defects as compared to controls. Percutaneous closure of Ventricular Septal Defect with Amplatzer occluders decreases the BNP levels.

Understanding the exact pathophysiological mechanism of degenerative aortic stenosis is important in order to develop new treatment modalities and prevent progression of the disease. Recently, most of the inflammatory markers in association with aortic stenosis have been described. The authors of the paper under evaluation investigate the effects of the 5-lipoxygenase pathway on aortic valve stenosis and correlation with severity of stenosis. In this article, we suggest that the 5-lipoxygenase pathway is one of the possible factors in the development of aortic stenosis.